﻿<?xml version="1.0" encoding="utf-8"?>
<!-- Individual Insurance Policy and Client Information -->
<TransactionSpecification TransactionSetIdentifierCode="111" xmlns="http://tempuri.org/X12ParserSpecification.xsd">
  <Segment SegmentId="BHT"/>
  <Loop LoopId="1000">
    <Name>Individual or Organization Name</Name>
    <StartingSegment SegmentId="NM1"/>
    <Segment SegmentId="N3"/>
    <Segment SegmentId="N4"/>
    <Segment SegmentId="REF"/>
    <Segment SegmentId="PER"/>
  </Loop>
  <HierarchicalLoop LoopId="2000">
    <Name/>
    <Segment SegmentId="REF"/>
    <Segment SegmentId="ASI"/>
    <Segment SegmentId="LQ"/>
    <Segment SegmentId="C3"/>
    <Segment SegmentId="DMG"/>
    <Segment SegmentId="LUI"/>
    <Segment SegmentId="N4"/>
    <Segment SegmentId="BLI"/>
    <Segment SegmentId="LIN"/>
    <Segment SegmentId="UDA"/>
    <Segment SegmentId="SPA"/>
    <Segment SegmentId="BLN"/>
    <Segment SegmentId="QTY"/>
    <Segment SegmentId="AMT"/>
    <Segment SegmentId="RPA"/>
    <Loop LoopId="2100">
      <Name>Payment Details</Name>
      <StartingSegment SegmentId="PDL"/>
      <Segment SegmentId="REF"/>
    </Loop>
    <Loop LoopId="2200">
      <Name>Information</Name>
      <StartingSegment SegmentId="III"/>
      <Segment SegmentId="DTP"/>
    </Loop>
    <Loop LoopId="2300">
      <Name>Information Values</Name>
      <StartingSegment SegmentId="AM1"/>
      <Segment SegmentId="III"/>
      <Segment SegmentId="SPA"/>
      <Segment SegmentId="DTP"/>
      <Segment SegmentId="AMT"/>
      <Segment SegmentId="QTY"/>
      <Segment SegmentId="RPA"/>
      <Segment SegmentId="BLN"/>
      <Segment SegmentId="REF"/>
    </Loop>
    <Loop LoopId="2400">
      <Name>Individual or Organizational Name</Name>
      <StartingSegment SegmentId="NM1"/>
      <Segment SegmentId="N2"/>
      <Segment SegmentId="COM"/>
      <Loop LoopId="2450">
        <Name>Party Location</Name>
        <StartingSegment SegmentId="N3"/>
        <Segment SegmentId="N4"/>
        <Segment SegmentId="DTP"/>
      </Loop>
    </Loop>
    <Loop LoopId="2500">
      <Name>Property or Entity Identifications</Name>
      <StartingSegment SegmentId="NX1"/>
      <Segment SegmentId="REF"/>
      <Segment SegmentId="BEN"/>
      <Segment SegmentId="III"/>
      <Segment SegmentId="AM1"/>
      <Segment SegmentId="IN1"/>
    </Loop>
  </HierarchicalLoop>
</TransactionSpecification>